54 NE 100 St (2)PERMIT APPLICATION FOR MIAMI SHORES VILLAGE
Date 0 3 -6 2_0 /Job, Address 5 N & J4D --c'7 Tax Folio
Legal Description Historically Designated: Yes No
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Owner/Lessee / Tenant i € t / // e „ir Master Permit # 41,g9t5
Owner's Address r*% I/ N. ��- /QO 57'` Phone 34s 75 - a 7 o 7
Contracting Co. ,4Z1 , )� 7 €2-/ UI °"` 6 Address 7 5O/ Z z1 •. cam`-`' Ati./
Qualifier / SS# - / -Phone fW — d T
State # # Competency # Ins. Co.
Address
Address
Architect/Engineer
Bonding Company
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBIN MECHANICAL O FING PAVING FENCE SIGN
WORK DESCRIPTION — fCG /€42 � — !'4' � d
Square Ft. Estimated Cost (value)
TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO DO SO MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER
OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.)
Application is hereby made to obtain a permit to do work and installation as indicated above, and on the attached addendum (if applicable). I certify that all work
will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL
PLUMBING, SIGNS, POOLS, ROOFING and MECHANICAL WORK.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will - be
construction and zoning. Furthermore, I authorize the above -named contractor to do the work stat
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Sign
My
FEES: PERMIT . RADON
APPROVED:
Zoning
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and/or Condo President Date
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President Date
JUAN PEREZ
My Comm Exp. 2/8/2003
No. CC 807544
[ 1 Personally Known that I.D.
Mechanical �" ' ° [ Plumbing
AMIA
uilder
F Ft
'¢ NOTA i' c
N PUaucj>
0
JUAN PEREZ
My Comm Exp. 2/8/200
No. CC 807544
:mangy tC,a ::n (1041.01.0.
Signature
No
My
ICI
' a l'''� actor or
, ss L Expires:
ne
C.C.F. / • g NOTARY " 0
in compli
a applicable laws
Date
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Building Electrical
Structural Engineer
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